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General NPI Number Information
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NPI Number | 1558463703
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Entity Type | Individual
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Provider Name | GINA QUEEN M.S.W., L.S.W.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1492 W FLAGLER ST
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City | MIAMI
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State | FL
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Zip | 33135-2209
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Country | US
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Telephone | 305-541-5864
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Fax |
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Provider Business Mailing Address
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Address Line | 2570 CENTERGATE DR
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City | MIRAMAR
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State | FL
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Zip | 33025-7256
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Country | US
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Telephone | 954-907-6387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0022496
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License Number State | OH
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